Job Description

Are you looking to join a team of like-minded professionals who are passionate about serving Douglas County OHP members, engaging with the community, and delivering outstanding customer service?

At Umpqua Health, we are committed to recruiting top-tier team members who provide exceptional service with professionalism, compassion, and respect for the unique needs of every individual we serve.

If you thrive in a fast-paced, dynamic healthcare environment and are ready to make a meaningful impact, you may be the team member we’re looking for.
We seek individuals who:

• Possess genuine compassion and empathy for our members
• Can adapt to ever-evolving healthcare regulations and requirements
• Are motivated by challenges and dedicated to delivering superior customer service

Join us in serving over 40,000 Douglas County residents as we administer Medicaid benefits and work together to improve health outcomes in our community.

Umpqua Health is a mission-driven, community-focused healthcare organization proudly serving Douglas County, Oregon. Locally owned by  CHI Mercy Health and the  Douglas County Individual Practice Association (DCIPA), we are deeply rooted in the region and dedicated to improving the health and well-being of our friends, families, and neighbors.

Umpqua Health is the parent company of Umpqua Health Alliance, one of 16 Oregon coordinated care organizations serving the Oregon Health Plan. The Roseburg-based company and its subsidiaries are focused on expanding access, improving care, and reducing unnecessary costs across the clinical space for more than 40,000 Douglas County residents on the Oregon Health Plan and close to 10,000 more individuals with Medicare, private insurance or Exchange coverage. Job Description

JOB TITLE	Pharmacy Technician I	REPORTS TO	Director of Pharmacy
STATUS	FT, Non Exempt	WAGE RANGE	Wage Band 13 (2024)
DEPARTMENT	Pharmacy	WORK LOCATION	Remote (occasional travel as required)

 

POSITION PURPOSE

Accountable for supporting medical management functions (utilization management, pharmacy management, and care coordination) with expertise in appropriate areas. Follow Umpqua Health Alliance’s policies and procedures, practice guidelines, state and federal guidelines and regulations, and other medical management resources. Serve as liaison to Oregon Health Plan members, providers, pharmacies, and community healthcare personnel.  Works under greater supervision with guidance from more experienced staff and focuses on performing standard medical management clinical review tasks.

 

ESSENTIAL JOB RESPONSIBILITIES

Regulatory Compliance:

• Maintain updated knowledge of the Oregon Administrative Rules (Medicaid) governing coverage determinations.
• Comply with organization’s internal policies and procedures, Code of Conduct, Compliance Plan, along with applicable Federal, State, and local regulations.

Utilization Review:

• Perform initial review of requests for coverage of pharmacy and medical services. Make decisions in a logical, consistent manner. Provide clear and accurate documentation of the reasoning process for decisions within allotted timeframes.
• Effectively navigate and apply the Health Evidence Review Commission Prioritized List of Health Services.
• Follow utilization management guidelines with few errors and consistently score 80% or above on inter-rater reliability (IRR) testing.
• Evaluate the cost and effectiveness of proposed/delivered services before, during, and after claims payment. Analyze claims data with consideration to medical necessity, the quality of care, and the appropriateness of the delivery of care, and covered benefits.
• Utilize applicable resources and systems to prepare materials for pharmacist review, including documentation of key findings, benefit determination, verification of codes and pricing, supporting standards citations, care plans, risk appraisals, and alternative treatment options.
• Communicates with providers on formulary or lower cost alternatives, prior authorizations, and step therapy guidelines as well as state and federal criteria for services and supplies.
• Perform data entry into claims adjudication system with a high level of accuracy.

Care Coordination:

• Assist with Medication Management program daily responsibilities including contacting members, pharmacies, and providers as needed to complete MedSynch and assist pharmacist with MM schedule.
• Assist other departments in coordinating medication services for members by answering questions and resolving identified barriers.
• Educate members and practitioners about the health plan benefit structure and relevant rights and responsibilities.
• As needed, work with the OHP Grievance and Appeals coordinator when they receive calls from a member or the member’s representative regarding concerns about the care being provided.
• Assisting pharmacies as needed to ensure timely dispensing of medications.
• Other duties as assigned.

 

CHALLENGES

• Working with a variety of personalities, maintaining a consistent and fair communication style.
• Satisfying the needs of a fast paced and challenging company.

 

QUALIFICATIONS

Minimum Qualifications

• Current National and Oregon Certified Pharmacy Technician (CPhT) licensure.
• 1+ years' experience as a pharmacy technician.
• Fluent in pharmaceutical and medical terminology.
• Proficient PC navigational, MS Office (Word, Excel, Outlook), data entry, and internet research skills.
• No suspension/exclusion/debarment from participation in federal health care programs (e.g. Medicare/Medicaid)

Preferred Qualifications

• Managed care experience.
• Ability to provide excellent customer service to internal and external customers.
• Effective written, verbal, and interpersonal communication skills.
• Ability to effectively collaborate with others and function as a part of a highly functioning team.
• Excellent self-discipline to meet deadlines and follow policies, procedures, and workflows in a remote environment.
• Excellent critical thinking and time management skills required to organize and prioritize workload according to goals and specified turnaround times.
• Demonstrated transferable knowledge, skills, and ability to complete job duties independently and proficiently.
• Experience considering the impacts of the work on multiple communities, including communities of color, in technical analysis.
• Proficient computer skills, including MS Office suite
• Experience considering the impacts of the work on multiple communities, including communities of color, in technical analysis.
• Experience working on a diverse team with different communication styles.
• Bi-lingual translation or translation capabilities a plus

 

PHYSICAL DEMANDS & WORK CONDITIONS

• A typical office environment requires standing, sitting, walking, bending, and lifting up to 25 plus pounds. 
• Ability to travel and drive to in-person meetings or be on-site as required.
• May be exposed to patient and environment conditions such as unpleasant sights, smells and contagious diseases (clinic only).

About Umpqua Health

At Umpqua Health, we're more than just a healthcare organization; we're a community-driven Coordinated Care Organization (CCO) committed to improving the health and well-being of individuals and families throughout our region. Umpqua Health serves Douglas County, Oregon, where we prioritize personalized care and innovative solutions to meet the diverse needs of our members. Our comprehensive services include primary care, specialty care, behavioral health services, and care coordination to ensure our members receive holistic, integrated healthcare. Our collaborative approach fosters a supportive environment where every team member plays a vital role in our mission to provide accessible, high-quality healthcare services. From preventative care to managing chronic conditions, we're dedicated to empowering healthier lives and building a stronger, healthier community together. Join us in making a difference at Umpqua Health.

Umpqua Health is an equal opportunity employer that embraces individuals from all backgrounds. We prohibit discrimination and harassment of any kind, ensuring that all employment decisions are based on qualifications, merit, and the needs of the business. Our dedication to fairness and equality extends to all aspects of employment, including hiring, training, promotion, and compensation, without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, veteran status, or any other protected category under federal, state, or local law.

Job Tags

Full time, Local area, Remote work,

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